The sedation mindset: philosophy, science, and practice.

Abstract

Medicine is evolving. An increasing influx of medically complex patients coupled with diminishing resources set the stage for substantial challenges in providing safe, effective sedation and analgesia for children requiring medical procedures. This review will discuss the essential components of a successful sedation plan outside of the traditional operating room setting. As the discipline of sedation has developed, specialty societies have created and updated guidelines, policies, and statements intended to guide their own practice. There is a lack of consensus among them regarding appropriate targeted depths of sedation, monitoring requirements, definitions of adverse events, resuscitation skills required, and appropriate sedatives used. A transparent, collaborative approach is needed to ensure the sharing of expertise and to encourage evidence-based consistency and safety optimization across venues and specialties. To meet this need, a multidisciplinary strategy is essential in training, performance of procedures outside of the operating room, and care coordination. To deliver safe, effective care, the sedationist must: perform a targeted presedation assessment; optimize the patient and family prior to sedation; tailor the induction and maintenance to the specific child's condition, needs, and procedure; safely recover the child; and provide a safe plan for postsedation care.